Physiology Practice Test 1 PDF OCT 2024

TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for October...

TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Which transport system reabsorbs glucose from the IMPORTANT LEGAL INFORMATION tubular fluid into the blood? A. Exocytosis 7. The handouts, videos and other review materials, provided by Topnotch Medical Board B. Na+-glucose cotransport Preparation Incorporated are duly protected by RA 8293 otherwise known as the C. Na+-K+ transport Intellectual Property Code of the Philippines, and shall only be for the sole use of the person: a) whose name appear on the handout or review material, b) person subscribed to Topnotch D. Facilitated transport Medical Board Preparation Incorporated Program or c) is the recipient of this electronic A woman with untreated DM has a GFR of 120 communication. No part of the handout, video or other review material may be reproduced, mL/min, a plasma glucose concentration of 400 shared, sold and distributed through any printed form, audio or video recording, electronic medium or machine-readable form, in whole or in part without the written consent of mg/dl, a urine glucose concentration of 2500 mg/dl, Topnotch Medical Board Preparation Incorporated. Any violation and or infringement, and urine flow rate of 4 ml/min. What is filtered load whether intended or otherwise shall be subject to legal action and prosecution to the full extent guaranteed by law. 8. in mg/min? A. 180 DISCLOSURE B. 280 The handouts/review materials must be treated with utmost confidentiality. It shall be the C. 480 responsibility of the person, whose name appears therein, that the handouts/review materials D. 380 are not photocopied or in any way reproduced, shared or lent to any person or disposed in any manner. Any handout/review material found in the possession of another person whose name A woman with untreated DM has a GFR of 120 does not appear therein shall be prima facie evidence of violation of RA 8293. Topnotch review mL/min, a plasma glucose concentration of 400 materials are updated every six (6) months based on the current trends and feedback. Please mg/dl, a urine glucose concentration of 2500 mg/dl, buy all recommended review books and other materials listed below. THIS HANDOUT IS NOT FOR SALE! and urine flow rate of 4 ml/min. What is excretion 9. rate in mg/min? A. 250 This handout is only valid for the October 2024 PLE batch. B. 100 This will be rendered obsolete for the next batch C. 200 since we update our handouts regularly. D. 300 A woman with untreated DM has a GFR of PHYSIOLOGY PRACTICE TEST 1 120mL/min, a plasma glucose concentration of 400 mg/dl, a urine glucose concentration of 2500 mg/dl, By Jonathan P. Chan, MD and urine flow rate of 4 ml/min. What is Contributors: Nick Cumigad, MD, Cody dela Cuesta, MD, 10. reabsorption rate? Kat Orteza, MD A. 280 mcg/min B. 150 mcg/min Which of the following changes can occur if a normal C. 380 mg/min person moves from a supine position to a standing D. 350 mg/min position? What happens to physiologic dead space of a normal 1. A. Decreased heart rate healthy subjects during exercise? B. Decreased venous resistance A. 20% increase of physiologic space from C. Decreased venous return baseline measurement D. Increased cardiac output B. 50% reduction of physiologic space from A 60-year-old hypertensive woman is found by 11. baseline measurement arteriography to have 50 percent narrowing of her C. 30% increase of physiologic space from left renal artery. If her heart is normal and her heart baseline measurement rate is 90 beats/min, what is the cardiac output in D. No change as long as the frequency of 2. L/min of her ventricle closest to? breathing per min is increased from baseline A. 8.00 Which of the following lung pathology is NOT a cause B. 6.75 of increased alveolar dead space? C. 4.55 A. Asthma D. 3.45 12. B. Emphysema More than how much in percent does the renal C. Pulmonary hypertension artery need to be narrowed before overall renal D. Bronchitis vascular resistance is increased enough to A healthy 60-year-old has a tidal volume (Vt) of 0.45L significantly decrease renal blood flow? 3. and a breathing frequency of 16 breaths per min. His A. 30 arterial PCO2 is 41 mmHg and the PCO2 of his expired B. 50 air is 35 mmHg. What is his dead space in L? C. 60 13. A. 1.065 D. 40 B. 0.667 Blood flow in the Poiseuille equation is affected only C. 1.634 by blood vessel caliber in which of the following D. 0.066 conditions? Which of the following is NOT part of the definition A. There is no co existing anemia in the patient of anatomic dead space? 4. B. Renal perfusion pressure was held constant A. It represents 39% of the tidal volume C. The equation is applicable to patients more B. The anatomic dead space is the volume of air than 50 years of age 14. in the nose trachea and bronchi D. Renal perfusion is variable between the right C. It represents the volume air that fills the and left renal artery conduction zone of the respiration A 60-year-old hypertensive woman is found by D. The normal anatomic dead space is 250 mL arteriography to have 50 percent narrowing of her A healthy 60-year-old has a tidal volume (Vt) of 0.45L left renal artery. What is the expected change in and a breathing frequency of 16 breaths per min. His blood flow through the stenotic artery using arterial PCO2 is 41 mmHg and the PCO2 of his expired 5. Poiseuille equation? air is 35 mmHg. What is his alveolar ventilation in A. Decrease to 15. L/min? B. No change A. 7.25 C. Decrease to 1/8 B. 6.14 D. Decrease to 1/16 C. 5.01 All filtered glucose will be reabsorbed below which D. 8.15 plasma concentration in mg/dl? What is a good approximate of left atrial pressure? A. 180 A. End Systolic pressure 6. B. 200 16. B. Pulmonary capillary wedge pressure C. 300 C. Left ventricular end diastolic pressure D. 250 D. Ejection fraction TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN Page 1 of 12 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. What bacteria caused diarrhea by stimulating Cl- Which statement about the endocrine system is NOT secretion? true? A. Entamoeba histolytica A. The target organ performs the function 17. B. Shigella dysenteriae B. The hormone exerts more and more its control C. Vibrio cholera 29. effect on the target organ D. Salmonella enterica C. The secretion of hormone is generally The rise of calcium ions is required in the skeletal controlled by negative feedback mechanism muscle to activate which of the following to cause D. The endocrine gland has a natural tendency to skeletal muscle contraction? under secrete its hormone 18. A. cAMP Which cell structures are poorly developed in atria? B. Troponin C A. Mitochondria C. Calmodulin 30. B. Tubules D. Protein kinase C C. Sarcoplasmic reticulum Barrel shape chest is indicative of which condition? D. Nuclear membrane A. Atelectasis What is the action of prostaglandin in the renal cortex? 19. B. Pneumothorax A. Decrease blood flow C. Emphysema 31. B. Increase blood flow D. Status asthmaticus C. Release of Angiotensin Which of the following are decreased by D. Vasoconstriction somatostatin? A blind spot is caused by lack of rods and cones in A. Gastric acid the retina over the optic disc. This is found how 20. B. Bile secretion many degrees lateral to the central point of vision? C. Insulin 32. A. 20 D. All of the above B. 35 Which substance does Heparin activate? C. 15 A. Protein C D. 30 21. B. Factor Xa Which the following is NOT a site of amino acid C. Antithrombin reabsorption D. Factor V Leiden A. Duodenum 33. Which of the following enzymes is deficient in B. Ileum FEMALE pseudohermaphroditism? C. Cecum A. 17-alpha hydroxylase D. Jejunum 22. B. 5 alpha-reductase What pattern of gastrointestinal motor functions C. 6 alpha-reductase occurs many hours after a meal or in fasting? D. 21-beta hydroxylase A. Mixing movements 34. Blood trauma would cause activation of which B. Propulsive movements factor? C. Migrating motor complex A. Factor VIIIa D. Relaxation of peristalsis 23. B. Factor XII Which is NOT an excretory product of the mother C. Factor IX that pass through the placental membrane? D. Factor XI A. CO2 35. Which type of placentation is present in humans? B. Creatinine A. Epitheliochorial C. Uric Acid 24. B. Sapiochorial D. Glucose C. Endotheliochorial What is produced when muscle contracts against a load? D. Hemochorial A. Contractions What condition results when a boy loses his testes 36. B. Energy before puberty? C. Work A. Hermaphroditism D. Metabolism 25. B. Ambiguous genitalia What type of heart sound is heard in Atrial Septal C. Eunuchism Defect? D. Dwarfism A. Paradoxical splitting 37. Which of the following is the cause of diarrhea in B. Fixed splitting patients with Vibrio cholera? C. Wide splitting A. Absorption of glucose and water is prevented D. Normal splitting B. Increase HCO3- secretory channels is intestinal The following statements about memory is true 26. epithelial cells EXCEPT which? C. Increase chloride secretory channels in crypt A. Most of the information storage occurs in the cells cerebral cortex D. Inhibition of cyclic adenosine monophosphate B. A large fraction of the important sensory 38. production is the intestinal epithelial cells information causes an immediate motor response Which of the following is NOT a sign of Cor C. Much of important sensory information to the pulmonale? brain is stored for future control of motor activities A. Edema D. The storage of information is the process we 27. B. Jugular venous distention call memory C. Circumoral cyanosis Which is the function of Peyer's patches? D. Hepatomegaly A. It is believed to phagocytose viral and bacterial elements Which has been reported by patients with COVID- B. Responsible for producing T lymphocytes 39. 19? C. Allows the absorption of Folic acid A. Low respiratory drive with normal resistance D. Contain specialized M cells that present and compliance antigen to immune cells B. Low respiratory drive with abnormal What is the effect on neuromuscular conduction of 28. resistance and compliance neostigmine? C. High respiratory drive with normal resistance A. Complete blockade of nerve transmission and compliance 40. B. Prolongs and enhances action of Ach at muscle D. High respiratory drive with abnormal end plate resistance and compliance C. Depletes Ach stores from presynaptic terminal D. Partial blockade of nerve transmission TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN Page 2 of 12 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Which does NOT belong to the same glycoprotein family? What are inputs that hyperpolarize the postsynaptic A. TSH cell, moving it away from threshold and farther from 41. B. FSH firing an action potential? C. Growth hormone 51. A. Many to one synapses D. LH B. One to one synapses Which is the correct order of thyroid hormone synthesis? C. Inhibitory postsynaptic potentials A. Iodine is oxidized then binds with D. Excitatory postsynaptic potentials thyroglobulin to form MIT which is next What triggers increased peristalsis in the ileum? iodinated in position 3 to form DIT, while two A. Opiate DITs form T4. T4 is converted to T3. 52. B. Water B. Iodide binds with thyroglobulin through the C. Food enzyme thyroxine peroxidase. to produce 2 D. Glucose molecules, monoiodotyrosine (MIT) and The following are differences between innate and diiodotyrosine (DIT). Both molecules undergo adaptive immunity EXCEPT which? oxidative condensation to form T3 and T4. A. Proteins such as C reactive are secreted for C. Thyroid peroxidase oxidizes Iodide which innate immunity while Immunoglobulins are 42. binds with tyrosine producing involved in adaptive immunity monoiodotyrosine (MIT). MIT is iodinated in B. Circulating antibodies are involved in adaptive the 5 position to form DIT, then coupling 53. immunity while cells such as neutrophils, reaction of two DITs or MIT plus DIT forms T4 macrophages and monocytes components of and T3 respectively. innate immunity D. Iodine trapping by tyrosine producing C. Physical barriers such as mucus and epithelial monoiodotyrosine (MIT), MIT attaches to cells are used in innate immunity thyroglobulin and binds with another MIT to D. Resistance persists through generation for form DIT, coupling reactions occur between both innate and adaptive Immunity MIT with DIT to produce T4 and two MIT to To diagnose blindness in specific portions of the produce T3 retinas, one can chart the field of vision for each by Which is NOT an effect of estrogens on the breasts? a process called ______. A. Growth of an extensive ductile system of the breasts 54. A. Optometry B. Development of the stromal tissue of the breasts B. Visual text 43. C. Deposition of fats in the breasts C. Perimetry D. Ultimate growth and function of the structures D. Optical field of the breast Where do the taste impulses in the anterior two Which is NOT a typical characteristic of a female? thirds of the tongue first pass? A. Narrow shoulder A. Abducens 55. 44. B. Thighs converge B. Facial C. Narrow Hips C. Trochlear D. Arms diverge D. Trigeminal Pain relief by opioids is due to? Which is NOT a neurotransmitter secreted by the A. Inhibition of prostaglandin E enteric neurons? 45. B. Inhibition of substance P A. Dopamine 56. C. Stimulation of glucocorticoids B. Glutamate D. Stimulation of GABA agonists C. Serotonin Which part of the brain does NOT provide "patterns" D. Cholecystokinin of motor activity? Which neuron releases nitric oxide? A. Premotor areas of the cortex A. Postganglionic sympathetic neurons 46. B. Corpus Callosum 57. B. Cholinergic neurons C. Basal ganglia C. Noradrenergic, noncholinergic neurons D. Primary motor cortex D. Adrenergic neurons The secretion of K+ by the distal tubule will be The following are involved in the chemical decreased by which of the following drugs? adjustments of ventilation EXCEPT A. Ethacrynic acid A. PO2 is raised when it falls to very low levels 47. 58. B. Furosemide B. Decrease carbonic acid to maintain RR C. Aldosterone C. Effect of excess H+ in the blood is counteracted D. Spironolactone D. Alveolar PCO2 is held constant Consider two compartments X and Y. Proteins in Changes in the conduction velocity, primarily in the compartment X are impermeable to membrane M but AV node is called the membrane is freely permeable to K+ and Cl- which A. Inotropic are present in both compartments in equal 59. B. Chronotropic concentrations. Cl- tends to diffuse down its C. Lusitropic concentration gradient from Y to X and some positively D. Dromotropic 48. charged K+ moves with it. Which compartment has a Which reflex is stimulated with the irritation of the more osmotically active particles? nasal passageway? A. Cannot be estimated A. Babinski B. Compartment X 60. B. Gag C. Same for X and Y C. Cough D. Compartment Y D. Sneeze Which of the following is NOT a response to Which fibers have faster conduction velocity? exercise? A. Skeletomotor fibers A. Increased CO2 production 61. B. Postganglionic autonomic efferent to the skin 49. B. Lactic acidosis C. Unmyelinated nerve fibers C. Increased O2 Consumption D. Postganglionic autonomic afferent to the skin D. V/Q ratio from apex to base becomes very variable and erratic What is the basic unit of the body? A. Nucleus 50. B. Cell C. Organelle D. Mitochondria TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN Page 3 of 12 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Which of the following statements about Red Blood Which drug does NOT decrease heart contractility? Cells is Correct? A. Acidosis A. The concentration of RBC in the blood controls 74. B. Hypoxia/hypercapnia the rate of red cell production C. Digitalis B. X-rays which destroys portion of the bone marrow D. Beta blockers 62. causes atrophy of the remaining bone marrow Clawing is seen in lesions or which affected nerves? C. The principal factor that stimulates red blood A. Proximal radius cell production are the reticulocytes 75. B. Proximal ulnar D. The rate of RBC production is the functional C. Distal Median ability of the cells to transport oxygen D. Distal Radial With the addition of fluid, which of the following will Which quantity approximates preload? NOT occur? A. Ejection fraction A. Plasma protein concentration decreases 76. B. End diastolic volume 63. B. ECF osmolarity is unchanged C. Heart rate C. Arterial blood pressure decreases D. End systolic volume D. Hematocrit decreases Which of the following is NOT true about the sensory Which of the following laboratory tests is used to receptors? measure the sign of ongoing inflammation? A. Sensory receptors are specialized epithelial cells A. White Blood Count B. Environmental signals that sensory receptors 64. B. Erythrocyte sedimentation rate 77. can detect are mechanical, light and sound C. Serum Ferritin C. The environmental signal that cannot be D. C-reactive protein detected by the sensory system is chemical Testosterone is converted by the 5-alpha reductase D. Sensory neurons transduce environmental to which? signals into neural signals A. Pregnenolone Thyroxine and epinephrine are derivatives of which 65. B. Deoxycortisol amino acid? C. Dehydroepiandrosterone A. Alanine 78. D. Dihydrotestosterone B. Tyrosine What is the final measure of muscle performance? C. Tryptophan A. Force D. Threonine 66. B. Endurance Which of the following is responsible for monosynaptic C. Elasticity excitation of ipsilateral homonymous muscle? D. Strength A. Subliminal occlusion reflex 79. Which is the MOST important output pathway from B. Flexor withdrawal reflex the motor cortex? C. Golgi tendon reflex (inverse myotatic) A. Rubrospinal tract D. Stretch reflex (Myotatic) 67. B. Corticospinal tract A 45-year-old man with uncontrolled Diabetes C. Reticulospinal tract mellitus is brought to the emergency room and was D. Spinothalamic tract given insulin. What is expected to occur in the Which transport across cell membrane occurs down patient after the insulin injection? 80. an electrochemical gradient? A. Increase in his urinary glucose A. Primary Active Transport B. Decrease of his blood pH 68. B. Carrier transport C. Reduce his compensatory hyperventilation C. Facilitated diffusion D. Increase of his Potassium D. Countertransport When does QRS complex begin in the electrocardiogram? Which autonomic receptor is blocked by A. After diastole hexamethonium at the ganglia but not the 81. B. Before onset of diastolic pressure neuromuscular junction? C. Slightly before the onset of ventricular systole 69. A. Adrenergic Beta 1 receptors D. After ventricular systole B. Cholinergic nicotinic receptors The entire outside surface of the cell has a loose C. Cholinergic muscarinic receptors carbohydrate coat called______. D. Adrenergic alpha receptors A. Glycolipids 82. Your patient was diagnosed to have osteoporosis B. Glycoproteins but can't tolerate any calcium preparations. Which C. Glycosides could be given to increase calcium absorption from D. Glycocalyx the intestine? Which inhibits the secretion of growth hormone by 70. A. Parathyroid hormone blocking the response of the anterior pituitary? B. Calcitonin A. Gonadotrophin releasing hormone 83. C. 1,25-dihydroxycholecalciferol B. Somatostatin D. Citrate magnesium C. Growth hormone White blood cells enter tissue spaces via what D. Somatomedins mechanism? Which is the first step in cell reproduction? A. Phagocytosis A. Mitosis 71. B. Simple diffusion 84. B. Enzyme activation C. Diapedesis C. Meiosis D. Endocytosis D. Replication of all DNA in the chromosomes Hypoxemia produces hyperventilation by a direct What waves are seen in EEG of awake adults with effect on which structure? eyes open? A. Phrenic nerve A. Alpha 72. 85. B. The carotid and aortic body chemoreceptors B. Delta C. Medullary chemoreceptors C. Beta D. Lung stretch receptors D. Slow Which is involved with lead-pipe rigidity and Hypoxemia produces hyperventilation by direct tremors as shown in Parkinson's diseases? effect on the A. Prefrontal cortex A. Medullary chemoreceptors 73. 86. B. Substantia nigra B. The carotid and aortic body chemoreceptors C. Primary motor cortex C. Lung stretch receptors D. Striatum of the basal ganglia D. Phrenic nerve TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN Page 4 of 12 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. What syndrome results from the accumulation in A change in total peripheral resistance will change the blood of breakdown products of protein which of the following? metabolism? A. Venous return alone 98. 87. A. Nephrotic B. It will be changed by mean arterial pressure B. Uremia C. Cardiac output alone C. Glomerulopathy D. Cardiac output and venous return D. Acidemia Which force does NOT determine fluid movement Which defect during embryogenesis is mostly through the capillary membrane? asymptomatic but may cause chronic abdominal A. Interstitial fluid pressure 99. pain and / or pancreatitis? B. Capillary pressure 88. A. Persistence of the uncinate process C. Plasma colloid osmotic pressure B. Pancreas divisum D. Intravenous pressure C. Annular pancreas If the resting membrane potential of a nerve is -70 D. Ampulla of Vater atresia my and the K+ equilibria potential is -85mV while Which cells are seen in patients with G6PD deficiency? Na+ is +65 mV. Which ion will the membrane be A. Bite cell more permeable at rest? 100. 89. B. Heinz bodies A. Neither C. Howell-Jolly bodies B. K+ D. Target cell C. Na+ Which reflex is opposite or inverse to the stretch reflex? D. Both Na+ and K+ A. Flexor withdrawal 90. B. Extension reflex C. Knee jerk DISCUSSION D. Golgi tendon reflex 1. C. DECREASED VENOUS RETURN Which statement is NOT associated with muscle In the supine position, blood volume is distributed throughout conduction prior to contraction? the body. Upon standing, there is a shift of about 500 mL of blood A. Postsynaptic ligand binding leads to muscle to the lower body and venous return decreases (Choice C). cell depolarization in the motor end plate Choices A and B are incorrect because in a normal individual, the B. Action potential depolarization opens heart rate and venous resistance increase in response to presynaptic voltage-gated Na+ channels decreased venous return. These compensatory mechanisms 91. inducing release of neurotransmitter take place in order to increase blood pressure to normal. C. Depolarization travels along muscle cell and Choice D is incorrect since cardiac output decreases as a result down the T-tubule. of the decrease in venous return. D. Depolarization of the voltage sensitive dihydropyridine receptor on the sarcoplasmic 2. B. 6.75 reticulum induces a conformational change in Cardiac Output is Stroke volume multiplied by the heart rate. the tubular membrane The normal stroke volume is approximately 70 mL. Thus, 70 mL The supplementation of O2 for hypoxemia will be times 90 bpm is 6300 mL/min or 6.3 L/min. Among the given most helpful if the person's predominant V/Q defect choices, the closest answer is 6.75 L/min. is? 92. A. V/Q = 0 3. C. 60 B. Dead space According to recent consensus guidelines, critical renal artery C. Low V/Q stenosis is defined as a reduction by more than 70% in the D. Shunt diameter of the renal artery. Among the choices, the closest Which immunoglobulin gives localized protection in value is 60%. tears and intestinal secretions? Source: Bailey SR, Beckman JA, Dao TD, Misra S, Sobieszczyk PS, White CJ, Wann LS, Bailey SR, Dao T, Aronow HD, et al. ACC/AHA/SCAI/SIR/SVM 2018 appropriate use criteria for peripheral artery intervention: a report of the American A. IgM College of Cardiology Appropriate Use Criteria Task Force, American Heart Association, Society for Cardiovascular 93. B. IgE Angiography and Interventions, Society of Interventional Radiology, and Society for Vascular Medicine.J Am Coll Cardiol. 2019; 73:214–237. doi: 10.1016/j.jacc.2018.10.002 C. IgG D. IgA 4. A. THERE IS NO CO EXISTING ANEMIA IN THE PATIENT What will NOT occur when you give isotonic fluid to The Poiseuille equation states that resistance to blood flow is a patient? equal to eight multiplied by the viscosity of blood times the A. ECF osmolarity is unchanged length of the blood vessel divided by pi times radius of the blood 94. B. Plasma protein concentration decreases vessel raised to the fourth power. C. Hematocrit decreases Choice A is correct since hematocrit influences blood viscosity. D. Arterial blood pressure decreases A low hematocrit level, also called anemia, is known to decrease Which is NOT an excretory product of the mother blood viscosity. Thus, anemia is a factor that affects resistance to that pass through the placental membrane? blood flow and it is independent of blood vessel caliber. A. Creatinine 95. B. CO2 5. D. DECREASE TO 1/16 C. Uric Acid A 50% narrowing means that the radius would be reduced to D. Glucose half. Since the radius is raised to the fourth power in the Poiseuille equation, the blood flow through the stenotic artery is A diffusion potential can ONLY be generated in a cell expected to change by a factor of 2^4 or 16 times. Thus, blood when flow through the stenotic artery will decrease to 1/16 of the A. The membrane hydrophilic original blood flow (Choice D). 96. B. The membrane is permeable to the ion C. The membrane is lipophilic 6. B. 200 D. The ions are positively charged The renal threshold for plasma glucose is 200 mg/dL. At this After an ileal resection, the following can be affected point, all filtered glucose will still be reabsorbed. Above this in the patient? value, some nephrons become saturated. At a glucose A. Metabolism of cholesterol is decreased concentration of 375 mg/mL or the transport maximum, all causing hyperlipidemia nephrons are saturated. 97. B. Bile acid pool become stagnant and can accumulate C. There is enhanced absorption of fat in the liver D. Bile acids are not recirculated to the liver but are excreted in the feces TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN Page 5 of 12 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. 7. B. NA+ - GLUCOSE COTRANSPORT 16. B. PULMONARY CAPILLARY WEDGE PRESSURE Sodium-glucose cotransporter-2 (SGLT-2) reabsorbs glucose in Pulmonary Capillary Wedge Pressure (Choice B) that is the Proximal Convoluted Tubule of the nephron. This transporter measured using a Swan-Ganz Catheter is a good estimate of left is a type of secondary active transport and it is inhibited by SGLT- atrial pressure. The right atrial pressure is estimated by 2 inhibitors, a class of anti-diabetic medications, which include measuring the Central Venous Pressure. canagliflozin, dapagliflozin, and empagliflozin. Choice A is incorrect because exocytosis is the type of transport 17. C. VIBRIO CHOLERA seen with hormones and neurotransmitters. Vibrio cholera (Choice C) releases the cholera toxin that Choice C is incorrect because Na+-K+ transport, with the use of increases intracellular cAMP in gastrointestinal mucosal cells, the Na+-K+-ATPase pump, moves sodium extracellularly and resulting in decreased absorption and increased secretion of potassium intracellularly. chloride in the digestive tract. Choice D is incorrect because facilitated transport is associated Choices A, B and D are incorrect because these bacterial with GLUT transporters, which transport glucose via facilitated pathogens cause diarrhea through the production of cytotoxins diffusion. However, GLUT transporters are NOT involved with that can bind to the epithelial surface of the intestines and cause the reabsorption of glucose from the tubular fluid. microvilli and mucosal damage. 8. C. 480 18. B. TROPONIN C Filtered load = GFR x [plasma] Ca2+ binds to Troponin C (Choice B) on the thin filaments to Excretion rate = V x [urine] cause a conformational change in troponin. This consequently Reabsorption rate = Filtered load - Excretion rate moves tropomyosin out of the way so that the cross-bridge cycle Secretion rate = Excretion rate - Filtered load may begin. The filtered load is equal to the GFR multiplied by plasma Choice A is incorrect because cAMP is activated by G-coupled glucose concentration. Thus, 120 ml/min x 400 mg/dl = receptors present in skeletal muscle fibers. 480mg/min. Choice C is incorrect because Calmodulin is the Troponin C counterpart found in smooth muscles. 9. B. 100 Choice D is incorrect because Protein Kinase C is an enzyme involved in the regulation of smooth muscle contraction. Excretion rate is equal to the urine flow rate (V) multiplied by urine concentration. Thus, 4 ml/min x 2500 mg/dl = 19. C. EMPHYSEMA 100mg/min. Barrel chest refers to an increase in the anterior posterior diameter of the chest wall resembling the shape of a barrel, most 10. C. 380 MG/MIN often associated with emphysema (Choice C). This is a result of Reabsorption rate is simply the difference between the filtered (1) increased compliance of the lungs that leads to the load and the excretion rate. Therefore, 480 mg/min - 100 accumulation of air pockets inside the thoracic cavity and (2) mg/min = 380 mg/min. increased compliance of the lungs that increases the intrathoracic pressure and allows the chest wall to naturally 11. D. NO CHANGE AS LONG AS FREQUENCY OF BREATHING expand outward. PER MIN IS INCREASED FROM BASELINE Choice A is incorrect because Atelectasis commonly presents Physiologic dead space is equal to the sum of the anatomic and with dullness on percussion and possible tracheal deviation. alveolar dead spaces. Choice B is incorrect because Pneumothorax is associated with The anatomic dead space is air from the nose up to the terminal hyperresonance on percussion and possible tracheal deviation. Bronchioles (also known as the conducting zone) that does NOT Choice D is incorrect because Status Asthmaticus is associated undergo gas exchange. It has a normal value of 150 mL. with inspiratory or expiratory wheezing, or worse, a silent chest. The alveolar dead space is air in the respiratory unit of the lung that does NOT undergo gas exchange. It has a normal value of 0 mL since 20. D. ALL OF THE ABOVE physiologically, all alveoli should be capable of gas exchange. Somatostatin is the ultimate inhibitory hormone. Hypothalamic However, when there is V/Q mismatch (e.g., asthma, emphysema, somatostatin that inhibits growth hormone. Pancreatic and bronchitis), there is increased alveolar dead space. somatostatin inhibits insulin (Choice C) and glucagon. Gastric Thus, for a normal healthy subject undergoing exercise, the somatostatin inhibits all GI hormones, including Gastrin that physiologic dead space should only be due to the constant produces hydrochloric acid, the main component of gastric acid anatomic dead space. (Choice A), and CCK that is involved in bile secretion (Choice B). 12. C. PULMONARY HYPERTENSION 21. C. ANTITHROMBIN Asthma (Choice A), Emphysema (Choice B), and Bronchitis Heparin binds to antithrombin III (Choice C) then inactivates (Choice D) are obstructive lung diseases that are associated with thrombin and Factor Xa (Choice B). Antithrombin inhibits active structural lung changes. These pathologies all cause increased forms of Factors IX, X, XI and XII. alveolar dead space due to V/Q mismatch. Choice A is incorrect because Protein C is activated by the binding of thrombin to thrombomodulin. 13. D. 0.066 Choice D is incorrect because Factor V Leiden is a point mutation 0.45 x (41-35)/41 = 0.0658 L in the factor V gene that increases the risk of thrombosis. This Using the Bohr equation, dead space is equal to tidal volume (VT) mutation leads to the absence of the binding site on factor V for multiplied by the difference between arterial PCO2 and expired activated Protein C. PCO2 divided by arterial PCO2. 22. D. 21-BETA HYDROXYLASE 14. D. THE NORMAL ANATOMIC DEAD SPACE IS 250 ML 21-beta hydroxylase is the enzyme associated with female The normal anatomic dead space is 150 ml or approximately pseudohermaphroditism, where patients are genotypically 30% of normal tidal volume of 500 mL. female (46XX) but present with ambiguous external genitalia Choices A, B and C are true characteristics of the anatomic dead due to virilization caused by excessive weak androgens. space. A deficiency in either 17-alpha hydroxylase (Choice A) or 5 alpha-reductase (Choice B) is associated with male 15. B. 6.14 pseudohermaphroditism, wherein a patient presents as (0.45-0.066) x 16 bpm = 6.14 L/min genotypically male (46XY) but has ambiguous external genitalia Alveolar ventilation is the difference between tidal volume (VT) or a complete female phenotype. and dead space multiplied by breathing frequency. VT and breathing frequency are given, but dead space must be calculated. Dead space is calculated using the Bohr equation wherein VT is multiplied by the difference between arterial PCO2 and expired PCO2 and divided by arterial PCO2. TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN Page 6 of 12 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. 23. B. FACTOR XII The blind spot is represented on a visual field chart by an Factor XII, also known as Hageman factor, initiates the intrinsic absolute scotoma and corresponds anatomically to the scleral pathway of coagulation. This could be activated by blood canal through which the retinal nerve fibers leave the eye at the trauma. Factor X is the final common pathway for the extrinsic optic disk. and intrinsic pathways. Choices A, C, and D are other clotting factors utilized in the 33. C. CECUM intrinsic pathway. Duodenum, jejunum, ileum (Choices A, B, and D) are parts of the small intestine and are sites of amino acid reabsorption. The 24. D. HEMOCHORIAL cecum (Choice C) is part of the large intestine and is NOT a site Humans have hemochorial type (Choice D) placentas. The where amino acids are reabsorbed. hemochorial type of placenta is seen in primates (e.g. humans, apes, monkeys), rodents, and rabbits. The epitheliochorial type 34. C. MIGRATING MOTOR COMPLEX (Choice A) is for horses, pigs, ruminants while the The pattern of gastrointestinal motor function while fasting or endotheliochorial type (Choice C) is for carnivores. Sapiochorial several hours after a meal is migrating/interdigestive type (Choice B) does not exist. motor/myoelectric complex. Even during fasting, migrating myoelectric complex (Choice C) 25. C. EUNUCHISM occur at 90-minute intervals and clear the stomach of residual A eunuch is a male without testes or whose testes failed to food. Motilin is the mediator of these contractions. develop. It is characterized by the lack of mature male germ cells Choices A, B, and D (mixing, propulsive and relaxing and testicular hormones. Across history, eunuchs would usually movements) are related with peristaltic movements and occur be castrated servants or slaves to make them less threatening after eating a meal due to GI distention, the most common servants of a royal court. stimulus of peristalsis. Choice A is incorrect because true hermaphrodites have both testicular and ovarian tissues present in either the same or 35. D. GLUCOSE opposite gonads. Take note that all of the choices have a low molecular weight of Choices B and D are incorrect because patients with ambiguous less than 1000 and therefore can pass through the placental genitalia and dwarfism may still possess testes before puberty. membrane. However, glucose (Choice D) is not an excretory product and is 26. C. INCREASE CHLORIDE SECRETORY CHANNELS IN CRYPT CELLS utilized by both the mother and the fetus since it is the major Cholera toxin acts by causing constitutive activation of source of energy of our cells. CO2, creatinine and uric acid adenylate cyclase, leading to elevated cAMP in intestinal (Choices A, B, and C) are excretory products. epithelial cells. cAMP activates protein kinase A, which causes the opening of ion channels in the membrane, leading to chloride 36. C. WORK and bicarbonate secretion by intestinal crypt cells and When a muscle contracts against a load, energy (choice B) in the disruption in absorption by villus cells. form of ATP is utilized, and is therefore a wrong answer. Energy is also converted from chemical to mechanical chemical when 27. C. CIRCUMORAL CYANOSIS ATP is hydrolysed during cross-bridge cycling and finally Among the choices, the best answer is circumoral cyanosis. Cor converted in the form of heat energy. pulmonale may result in peripheral cyanosis, which causes Contractions (Choice A) and metabolism (Choice D) are bluish discoloration of the distal extremities (hands, fingertips, processes that the muscle undergoes when it contracts. toes) but generally not mucous membranes. Circumoral Muscle work (Choice C) is roughly defined as the useful force cyanosis is seen in central cyanosis. that is produced when it contracts against a load. Among the choices, this is the best answer. 28. D. HIGH RESPIRATORY DRIVE WITH ABNORMAL 37. B. FIXED SPLITTING RESISTANCE AND COMPLIANCE Atrial Septal Defect causes a fixed split (Choice B). Shunting of Various published researches regarding the pathophysiology of blood from Left Atrium to Right atrium causes more blood to flow COVID-19 support that patients have a high respiratory drive through the pulmonic valve. Despite changes to the intrathoracic with abnormal resistance patterns. pressure, this shunt is maintained. As such, the split is fixed since there is a constant pressure gradient from left to right. 29. B. THE HORMONE EXERTS MORE AND MORE ITS CONTROL Paradoxical splitting (Choice A): L bundle branch block EFFECT ON THE TARGET ORGAN Wide splitting (Choice C): R BBB, PS, MVR, VSD If an endocrine gland senses that there is too much of one Normal splitting (Choice D): Also known as physiologic splitting hormone in the body, it will initiate changes to decrease of S2, heard upon inspiration production of that hormone in a negative feedback effect. Choices A, C and D are true statements about the endocrine 38. C. MUCH OF IMPORTANT SENSORY INFORMATION TO THE system. BRAIN IS STORED FOR FUTURE CONTROL OF MOTOR ACTIVITIES 30. B. TUBULES Memory is the process of storing information (Choice D) in the T tubules are invaginations of the cell membrane at the Z lines brain, primarily in the cerebral cortex (Choice A). A large and carry action potentials into the cell interior. They are well- fraction of sensory information causes an immediate motor developed in ventricles but poorly developed in atria. response, as in a reflex (Choice B). Therefore, choices A, B and D Notably, cardiac muscle cells have the greatest number of are correct statements. mitochondria (Choice A) due to the heart’s energy As such, this kind of sensory information is not stored in the brain. requirements. Choice C is the incorrect statement and the correct answer. 31. B. INCREASE BLOOD FLOW 39. D. CONTAIN SPECIALIZED M CELLS THAT PRESENT Prostaglandins vasodilate the afferent arterioles thereby ANTIGEN TO IMMUNE CELLS increasing blood flow (Choice B). Peyer's patches are a group of well-organized lymphoid follicles Release of angiotensin (Choice C) is triggered by low blood located in the lamina propria and submucosa of the distal pressure. portion of the small intestine. Peyer's patches at their apices contain M (microfold) cells, enterocytes expressing MHC class II 32. C. 15 (Choice D). A vertical line bisects central fixation and divides the visual field Phagocytosis of viral and bacterial elements (Choice A) is a into a nasal and temporal hemifield. Situated in the temporal function of the macrophages inside the Peyer’s patches. T hemifield is the normal blind spot approximately 12 to 17 lymphocytes are only located in the Peyer’s patches and are not degrees from fixation and 1.5 degrees below the horizontal exclusively responsible for its production (Choice B). meridian. Among the choices, 15 (Choice C) is the best answer. Absorption of folic acid (Choice C) mainly occurs in the duodenum and jejunum. TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN Page 7 of 12 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP PHYSIOLOGY PRACTICE TEST 1 HANDOUT BY DR. JONATHAN CHAN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for October 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. 40. B. PROLONGS AND ENHANCES ACTION OF ACH AT MUSCLE 47. D. SPIRONOLACTONE END PLATE K+ sparing diuretics like Spironolactone (Choice D) decrease K+ Prolongation and enhancement of Ach at the muscle end plate secretion. In fact, they cause hyperkalemia when used alone. (Choice B) is the effect of neostigmine due to the inhibition of Aldosterone (Choice C), which is known to INCREASE secretion acetylcholinesterase enzyme. of K+, is antagonized by Spironolactone. The most important use Other NMJ drugs of importance include botulinum, which blocks of the K+-sparing diuretics is in combination with thiazide or release of Ach from presynaptic terminals (Choice C); curare, loop diuretics to offset/reduce urinary K+ losses caused by these which competes with ACh for receptors on motor end plate; and drug classes. Ethacrynic acid (Choice A) and Furosemide (Choice hemicholinium, which blocks reuptake of choline into B) are loop diuretics. presynaptic terminal. 48. B. COMPARTMENT X 41. C. GROWTH HORMONE By definition, an effective osmole is one that has no to minimal Growth hormone uses enzyme-linked receptors (tyrosine- solute penetration. Since proteins in compartment X are associated kinase) → Src and JAK/STAT proteins. impermeable to the given membrane, compartment X (Choice B) Meanwhile, TSH (Choice A), FSH (Choice B), and LH (Choice D) contains more osmotically active particles. all make use of G protein coupled receptors. It can be estimated from the rationale above, therefore choice A is wrong. This also goes for compartment Y (Choice D). 42. C. THYROID PEROXIDASE OXIDIZES IODIDE WHICH The only scenario that osmotically particles for X and Y are the BINDS WITH TYROSINE PRODUCING MONOIODOTYROSINE same (Choice C) would be if all compartments are in (MIT). MIT IS IODINATED IN THE 5 POSITION TO FORM DIT, equilibrium. THEN COUPLING REACTION OF TWO DITS OR MIT PLUS DIT FORMS T4 AND T3 RESPECTIV